| NPI | 1740703222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DE C1-0028357) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0104577) |
| 207R00000X Internal Medicine (Licence: PA MD470638) | |
| Enumeration Date | 2017-07-17 |
| Last Update Date | 2025-09-02 |