| NPI | 1003483934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ND 20000) |
| Additional Taxonomies | 208600000X Surgery (Licence: ND RL17429) |
| Enumeration Date | 2021-06-09 |
| Last Update Date | 2024-03-28 |