| NPI | 1174031686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1214) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PR 19833) |
| Enumeration Date | 2018-01-18 |
| Last Update Date | 2021-01-07 |