| NPI | 1033195490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 5244) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 5244) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2016-05-03 |