| NPI | 1205063906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 2618) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102203044) |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2026-01-12 |