| NPI | 1487359287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 70004741) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 15054) |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2026-05-27 |