| NPI | 1942648837 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: MI 4301508248)  | 
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology (Licence: NM MD2020-0757)  | 
| 208600000X Surgery (Licence: IL 125-063214)  | |
| 208600000X Surgery (Licence: NY 291464)  | |
| 208600000X Surgery (Licence: MI 4301508248)  | |
| 208600000X Surgery (Licence: IL 036141167)  | |
| Enumeration Date | 2013-06-12 | 
| Last Update Date | 2025-10-13 |