| NPI | 1700088093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN215) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA3741) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2020-12-16 |