| NPI | 1710080601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ACN361) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 10945) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2018-03-27 |