| NPI | 1386167575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ACN967) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 19729) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2025-03-14 |