| NPI | 1497174270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DE C1-0013180) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301105938) |
| 208000000X Pediatrics (Licence: MI 4301105938) | |
| 208000000X Pediatrics (Licence: DE C1-0013180) | |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2019-07-02 |