| NPI | 1083241459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD484881) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DE C1-0026164) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2024-06-27 |