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 |