| NPI | 1871170191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: TX W5245) |
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology (Licence: TX BP10076201) |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2026-04-24 |