| NPI | 1205127172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DE C1-0010457) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0079030) |
| 207R00000X Internal Medicine (Licence: PA d79030) | |
| 208000000X Pediatrics (Licence: DE C1-0010457) | |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2025-08-05 |