| NPI | 1194827600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN844) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL CI 487) |
| 208D00000X General Practice (Licence: PR 019308) | |
| Enumeration Date | 2006-09-04 |
| Last Update Date | 2023-07-05 |