| NPI | 1134866866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 81820-21) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.079273) |
| Enumeration Date | 2022-05-14 |
| Last Update Date | 2025-07-25 |