| NPI | 1043273519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN 292) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN292) |
| 261Q00000X Clinic/Center (Licence: FL ACN292) | |
| 208D00000X General Practice (Licence: PR 13735) | |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2024-05-22 |