| NPI | 1912587353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 81490-21) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5151014952) |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2024-06-28 |