| NPI | 1417616632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1432) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 022581) |
| Enumeration Date | 2021-12-15 |
| Last Update Date | 2022-06-20 |