| NPI | 1871687699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 2745) |
| Additional Taxonomies | 208600000X Surgery (Licence: OK 2745) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2021-05-24 |