| NPI | 1740282490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 15018R) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AR E3519) |
| 207Q00000X Family Medicine (Licence: AR E3519) | |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2023-03-07 |