| NPI | 1902124456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DE C1-0013249) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.124068) |
| 208000000X Pediatrics (Licence: OH 35.124068) | |
| 208000000X Pediatrics (Licence: DE C1-0013249) | |
| Enumeration Date | 2010-05-07 |
| Last Update Date | 2019-08-21 |