| NPI | 1861929952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV SL1203) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NV DO2637) |
| Enumeration Date | 2017-05-19 |
| Last Update Date | 2020-01-09 |