| NPI | 1790964963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: TX Q4925) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 24562) |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2019-08-12 |