| NPI | 1295451565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ACN1501) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 23027) |
| Enumeration Date | 2022-10-18 |
| Last Update Date | 2023-03-24 |