| NPI | 1306474010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1281) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 15137-i) |
| Enumeration Date | 2020-03-29 |
| Last Update Date | 2024-03-05 |