| NPI | 1245784354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D93847) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DE C1-0013093) |
| Enumeration Date | 2016-08-05 |
| Last Update Date | 2022-06-17 |