| NPI | 1386794410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: ND 10780) |
| Additional Taxonomies | 208600000X Surgery (Licence: ND 10780) |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2023-09-05 |