| NPI | 1356020747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1616) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 23670) |
| Enumeration Date | 2023-07-13 |
| Last Update Date | 2024-07-29 |