| NPI | 1407409386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1234) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ACN1234) |
| 208D00000X General Practice (Licence: PR 21503) | |
| Enumeration Date | 2019-07-19 |
| Last Update Date | 2025-07-28 |