| NPI | 1700518735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1449) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 22808) |
| Enumeration Date | 2022-06-28 |
| Last Update Date | 2024-06-11 |