| NPI | 1639737273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1164) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 21352) |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2020-01-29 |