| NPI | 1407293103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 58967) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R74099) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2020-03-04 |