| NPI | 1336687656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1233) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 21123) |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2022-08-24 |