| NPI | 1417934217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 14385) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ACN608) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2019-09-19 |