| NPI | 1003848664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X (Licence: GA 31085) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: GA 31085) |
| 207QB0002X Family Medicine, Bariatric Medicine (Licence: GA 31085) | |
| 208D00000X General Practice (Licence: GA 31085) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2025-08-27 |