| NPI | 1497384846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1434) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 21868) |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2024-11-15 |