| NPI | 1346866407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1402) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 22465) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 15-361-I) | |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2022-12-16 |