| NPI | 1144392036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: AK MEDS1619) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 1619) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2025-05-12 |