| NPI | 1114586732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MT218318) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01095935A) |
| Enumeration Date | 2019-06-07 |
| Last Update Date | 2025-05-16 |