| NPI | 1528002227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO DR.0066105) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2021-05-25 |