| NPI | 1578200846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1604) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 16124-I) |
| 208D00000X General Practice (Licence: PR 23478) | |
| Enumeration Date | 2022-05-17 |
| Last Update Date | 2024-02-05 |