| NPI | 1609931138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: KS 0421987) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO R8G50) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2020-10-08 |