| NPI | 1063504264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C1-0002783) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0033925) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2024-06-25 |