| NPI | 1316926090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS 007183 L) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 01022011818) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2025-09-11 |