| NPI | 1528761335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 86861-20) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301516895) |
| Enumeration Date | 2023-03-22 |
| Last Update Date | 2026-06-27 |