| NPI | 1598708901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 5764) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NV 5764) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2022-10-14 |