| NPI | 1144193244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4351055483) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 102029851) |
| Enumeration Date | 2025-09-25 |
| Last Update Date | 2026-04-18 |