| NPI | 1700694718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ACN1702) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: PR 16875I) |
| Enumeration Date | 2024-12-23 |
| Last Update Date | 2025-08-01 |