| NPI | 1780104364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301505758) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301113142) |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2023-01-18 |