| NPI | 1881180784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DE C1-0024012) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0102948) |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2025-04-08 |