| NPI | 1124518196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NV DO2827) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV SL1340) |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2021-02-18 |