| NPI | 1679760680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ACN1060) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 17940) |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2025-12-10 |