| NPI | 1710473889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1122) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19992) |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2025-11-21 |