| NPI | 1447903661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1513) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 023133) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 16073I) | |
| Enumeration Date | 2022-01-28 |
| Last Update Date | 2023-04-17 |