| NPI | 1871113605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: MA PA7925) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NH 2811) |
| Enumeration Date | 2020-04-22 |
| Last Update Date | 2024-06-11 |