| NPI | 1710630181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1527) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 23004) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-01-27 |
| Last Update Date | 2023-08-30 |