| NPI | 1598416265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1598) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 23611) |
| Enumeration Date | 2022-01-14 |
| Last Update Date | 2024-02-01 |