| NPI | 1003071572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301507817) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301507817) |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2026-02-16 |