| NPI | 1639600018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: GA 104931) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP60935858) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2025-08-14 |