| NPI | 1245979160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1458) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 15808) |
| 208D00000X General Practice (Licence: PR 022794) | |
| Enumeration Date | 2022-05-31 |
| Last Update Date | 2023-06-22 |