| NPI | 1821258898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: OH 35131811) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX Q0685) |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2018-02-13 |