| NPI | 1518950997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 17024) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 17024) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2024-11-20 |