| NPI | 1164453767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1220) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ACN1220) |
| 207P00000X Emergency Medicine (Licence: PR 8065) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2023-08-03 |