| NPI | 1912402744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV DO3118) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AZ 008400) |
| Enumeration Date | 2018-03-25 |
| Last Update Date | 2022-05-10 |