| NPI | 1003407172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1377) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 022175) |
| Enumeration Date | 2021-02-01 |
| Last Update Date | 2024-08-05 |