NPI | 1316198005 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111NR0400X (Licence: DE F1-0000721) |
Additional Taxonomies | 208D00000X General Practice (Licence: DE F1-0000721) |
Enumeration Date | 2008-10-01 |
Last Update Date | 2020-04-23 |