| NPI | 1184863631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 003499) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: CO DR.0054622) |
| 208600000X Surgery (Licence: CO DR.0054622) | |
| Enumeration Date | 2009-02-06 |
| Last Update Date | 2024-04-17 |