| NPI | 1871609933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60693493) |
| Additional Taxonomies | 2086X0206X Surgery Surgical Oncology (Licence: FL ME106619) |
| 2086X0206X Surgery Surgical Oncology (Licence: WV 23169) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2021-04-05 |