| NPI | 1881220101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: KS 04-45623) |
| Additional Taxonomies | 208D00000X General Practice (Licence: KS 12345) |
| Enumeration Date | 2020-03-18 |
| Last Update Date | 2021-12-15 |