| NPI | 1366911471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1356) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 21111) |
| Enumeration Date | 2018-11-19 |
| Last Update Date | 2022-03-24 |