| NPI | 1144561184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1315) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19588) |
| Enumeration Date | 2013-03-14 |
| Last Update Date | 2025-04-01 |