| NPI | 1609022862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1637) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 023919) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 16520-I) | |
| Enumeration Date | 2008-08-07 |
| Last Update Date | 2024-07-12 |