| NPI | 1306520291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ACN1581) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN1581) |
| Enumeration Date | 2023-06-12 |
| Last Update Date | 2025-01-21 |