| NPI | 1083273015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IA R-12901) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 000000000) |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2023-06-14 |