| NPI | 1801895180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA G56505) |
| Additional Taxonomies | 2086X0206X Surgery Surgical Oncology (Licence: CA G56505) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2013-07-15 |