| NPI | 1770770604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2024-03098) |
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology (Licence: MD D0071814) |
| 208600000X Surgery (Licence: LA MD.200665) | |
| 208600000X Surgery (Licence: MO 2007016513) | |
| 2086X0206X Surgery, Surgical Oncology (Licence: WI 61018) | |
| Enumeration Date | 2007-09-25 |
| Last Update Date | 2026-05-28 |