| NPI | 1417721929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1726) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 23564) |
| Enumeration Date | 2023-11-14 |
| Last Update Date | 2026-08-19 |