| NPI | 1215700380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1698) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 24198) |
| Enumeration Date | 2023-11-01 |
| Last Update Date | 2025-02-10 |