| NPI | 1548366354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AR C5458) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR C5458) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2015-10-20 |