| NPI | 1689090060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NV DO2475) |
| Additional Taxonomies | 208D00000X General Practice (Licence: KS 05-45247) |
| 208D00000X General Practice (Licence: AZ 007214) | |
| 208D00000X General Practice (Licence: UT 11532150-1204) | |
| 208D00000X General Practice (Licence: CA 20A13585) | |
| Enumeration Date | 2014-03-10 |
| Last Update Date | 2024-07-19 |