| NPI | 1477263937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1614) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 14610-I) |
| 208D00000X General Practice (Licence: PR 023146) | |
| Enumeration Date | 2022-11-24 |
| Last Update Date | 2024-06-24 |