| NPI | 1598230088 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES A PORTERA Sole Member 907-868-2075 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology |
| Additional Taxonomies | 208600000X Surgery |
| Enumeration Date | 2018-10-10 |
| Last Update Date | 2018-10-10 |