| NPI | 1265784144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ACN119) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: PR 011694) |
| Enumeration Date | 2012-10-03 |
| Last Update Date | 2012-10-03 |