| NPI | 1932528684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101258985) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101258985) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2020-08-21 |