| NPI | 1770753071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA10168000) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 276423) |
| 208600000X Surgery (Licence: WI 70271) | |
| 208600000X Surgery (Licence: MD D0078498) | |
| 2086X0206X Surgery, Surgical Oncology (Licence: WI 70271) | |
| Enumeration Date | 2008-03-03 |
| Last Update Date | 2021-01-23 |