| NPI | 1922535509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: WA 61638236) |
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology (Licence: VA 0116038615) |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2025-07-30 |