| NPI | 1871932822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: NY 337815) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35127433) |
| 208600000X Surgery (Licence: NY 337815) | |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2025-06-23 |