| NPI | 1033759089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ACN1417) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: KY 58796) |
| 208D00000X General Practice (Licence: FL ACN1417) | |
| Enumeration Date | 2020-01-07 |
| Last Update Date | 2025-01-01 |