| NPI | 1780213959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ R78626) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4351046741) |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2024-05-30 |