| NPI | 1730476128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DE C2-0011252) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA OT014355) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2015-04-08 |