| NPI | 1740218973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME30422) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: FL 30422) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2019-12-05 |