| NPI | 1164038162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1309) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 21969) |
| Enumeration Date | 2020-09-16 |
| Last Update Date | 2025-10-16 |