| NPI | 1245752021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1397) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PR 22415) |
| 207Q00000X Family Medicine (Licence: PR 22415) | |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2022-03-17 |