| NPI | 1649745563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ACN1163) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ TL168) |
| Enumeration Date | 2018-10-07 |
| Last Update Date | 2020-02-18 |