| NPI | 1740743350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 100668) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 055020381) |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2024-07-19 |