| NPI | 1326539388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1229) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208D00000X General Practice (Licence: PR 21434) | |
| Enumeration Date | 2018-05-25 |
| Last Update Date | 2022-08-12 |