| NPI | 1053717942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1746) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2014-11-05 |
| Last Update Date | 2025-09-17 |