| NPI | 1730289505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1626) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 13796) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2025-01-10 |