| NPI | 1174968069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 192308) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME147193) |
| Enumeration Date | 2013-05-06 |
| Last Update Date | 2022-09-07 |