| NPI | 1659791754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DE C1-0012092) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD464162) |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2018-07-03 |