| NPI | 1932337227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: MI 4301094156) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 208600000X Surgery (Licence: MI 4301094156) | |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2024-06-10 |