| NPI | 1538222450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 41223) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 2187-020) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2023-11-02 |