| NPI | 1184889107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 25195) |
| Additional Taxonomies | 208600000X Surgery (Licence: WV 25195) |
| Enumeration Date | 2008-07-21 |
| Last Update Date | 2026-08-04 |