| NPI | 1871741694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301101807) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0116020489) |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2019-05-03 |