| NPI | 1790768265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NM 2003-0073) |
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology (Licence: NM 2003-0073) |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2016-04-11 |