| NPI | 1922413509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 86544) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: GA 86544) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: GA 86544) | |
| 208D00000X General Practice (Licence: GA 86544) | |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2021-08-24 |