| NPI | 1760483358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101242458) |
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology (Licence: CA G58333) |
| 208600000X Surgery (Licence: NC 2015-02261) | |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2021-11-10 |