| NPI | 1982618112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX K4862) |
| Additional Taxonomies | 208600000X Surgery (Licence: ID MC-2661) |
| 208600000X Surgery (Licence: MD D57659) | |
| 261QM1300X Clinic/Center, Multi-Specialty (Licence: TX K4862) | |
| 2086X0206X Surgery, Surgical Oncology (Licence: MO 2008010215) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2026-02-20 |