| NPI | 1487092797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083B0002X Preventive Medicine, Obesity Medicine (Licence: MO 2017016559) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 0445968) |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2013-06-08 |
| Last Update Date | 2026-03-12 |