| NPI | 1164977633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ACN917) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN917) |
| 208D00000X General Practice (Licence: PR 19433) | |
| Enumeration Date | 2016-08-24 |
| Last Update Date | 2021-09-07 |