| NPI | 1912587098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD492661) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DE C1-0027213) |
| 207R00000X Internal Medicine (Licence: MD D0100784) | |
| Enumeration Date | 2021-04-12 |
| Last Update Date | 2026-07-01 |