| NPI | 1972952422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A203171) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301117353) |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2025-09-05 |