| NPI | 1710424320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1051) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ACN1051) |
| 208D00000X General Practice (Licence: PR 19495) | |
| Enumeration Date | 2017-01-21 |
| Last Update Date | 2022-11-03 |