| NPI | 1689104358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301504892) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WY 14519A) |
| 208600000X Surgery (Licence: MI 4301504892) | |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2023-12-29 |