| NPI | 1205060217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DE C1-0009553) |
| Additional Taxonomies | 208D00000X General Practice (Licence: DE C1-0009553) |
| Enumeration Date | 2009-05-05 |
| Last Update Date | 2025-09-17 |