| NPI | 1851382881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ACN838) |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine (Licence: FL ACN838) |
| 208D00000X General Practice (Licence: FL ACN838) | |
| 208D00000X General Practice (Licence: PR 12736) | |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2023-03-07 |