| NPI | 1952693251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 72599) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN15961) |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2015-12-09 |