| NPI | 1689836355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 63548) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 003081) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2021-05-05 |