| NPI | 1619176583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN217) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ACN217) |
| 207R00000X Internal Medicine (Licence: PR 016263) | |
| 208D00000X General Practice (Licence: FL 217) | |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2020-08-17 |