| NPI | 1609434919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DE C2-0024074) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 73733) |
| Enumeration Date | 2019-06-01 |
| Last Update Date | 2023-03-24 |