| NPI | 1497404008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125080369) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125.080369) |
| Enumeration Date | 2022-03-21 |
| Last Update Date | 2023-05-16 |