| NPI | 1528760345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 04-53387) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-53387) |
| Enumeration Date | 2023-03-17 |
| Last Update Date | 2026-07-06 |