| NPI | 1750906012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 91653) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 12000) |
| 208D00000X General Practice (Licence: GA 91653) | |
| Enumeration Date | 2020-06-12 |
| Last Update Date | 2025-07-15 |