| NPI | 1740729136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ACN985) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ACN985) |
| Enumeration Date | 2017-02-17 |
| Last Update Date | 2021-12-16 |