| NPI | 1841771904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: WA NT60892302) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 20-1879) |
| 207Q00000X Family Medicine (Licence: VT 099.0134059) | |
| 208D00000X General Practice (Licence: CA 1007) | |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2020-11-27 |