| NPI | 1699393801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 43171) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 337896) |
| Enumeration Date | 2020-07-14 |
| Last Update Date | 2026-01-05 |