| NPI | 1922108232 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: AR E-5623)  | 
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology (Licence: TX M0652)  | 
| Enumeration Date | 2006-09-25 | 
| Last Update Date | 2008-12-17 |