| NPI | 1083279921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NV DO3005) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV SL1422) |
| Enumeration Date | 2019-05-06 |
| Last Update Date | 2021-12-16 |