| NPI | 1083153761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ACN962) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 19664) |
| Enumeration Date | 2017-02-15 |
| Last Update Date | 2022-08-31 |