| NPI | 1043956741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1503) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 22914) |
| Enumeration Date | 2022-05-06 |
| Last Update Date | 2025-10-16 |