| NPI | 1164628236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ACN1727) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 15511) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2025-07-22 |