| NPI | 1457549685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A119639) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A119639) |
| Enumeration Date | 2007-10-12 |
| Last Update Date | 2026-07-01 |