| NPI | 1629481080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 54374) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R74568) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2019-02-19 |