| NPI | 1982602363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: OH 35093341) |
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology (Licence: NY 198744) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2011-05-03 |