| NPI | 1861496580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX J-0651) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX J0651) |
| 208600000X Surgery (Licence: TX J-0651) | |
| 2086X0206X Surgery Surgical Oncology (Licence: TX J0651) | |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2021-07-21 |