| NPI | 1386242253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 22049) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN1322) |
| Enumeration Date | 2020-10-13 |
| Last Update Date | 2024-12-09 |