| NPI | 1679995369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 17827) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN341) |
| Enumeration Date | 2014-01-14 |
| Last Update Date | 2025-02-05 |