| NPI | 1366905879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE c2-0024316) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DE c2-0024316) |
| 208000000X Pediatrics (Licence: DE c2-0024316) | |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2023-07-21 |