| NPI | 1821341603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DE C7-0017650) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 307030) |
| Enumeration Date | 2012-10-18 |
| Last Update Date | 2022-06-05 |