| NPI | 1700467750 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DE C2-0024678)  | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD H0102936)  | 
| Enumeration Date | 2021-04-20 | 
| Last Update Date | 2025-06-26 |