| NPI | 1154523868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 15259) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN1722) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2025-10-01 |