| NPI | 1235561267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101277839) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DE C1-0010565) |
| Enumeration Date | 2013-08-01 |
| Last Update Date | 2023-04-28 |