| NPI | 1780813980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: NM MD2016-0775) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX P9693) |
| 2086X0206X Surgery, Surgical Oncology (Licence: TX P9693) | |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2016-10-12 |