| NPI | 1063131605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1576) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 23451) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-08-25 |
| Last Update Date | 2024-08-14 |