| NPI | 1073187605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2024-00452) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC KLIN-Q78I8P) |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2024-08-13 |