| NPI | 1780678227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: CT 044473) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 175417) |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2015-07-31 |