| NPI | 1700315926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 271788) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DE C1-0028544) |
| Enumeration Date | 2017-06-09 |
| Last Update Date | 2025-09-17 |