| NPI | 1972057891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX 48928) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 30668) |
| 208600000X Surgery (Licence: WI 21214) | |
| 2086X0206X Surgery, Surgical Oncology (Licence: TX 48928) | |
| Enumeration Date | 2016-08-09 |
| Last Update Date | 2025-10-14 |