| NPI | 1548464944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C1-0011887) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DE C7-0003778) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2025-10-08 |