| NPI | 1659869147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME162441) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10079355) |
| 208600000X Surgery (Licence: MI 208600000x) | |
| Enumeration Date | 2018-04-30 |
| Last Update Date | 2023-08-22 |