| NPI | 1730738790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ACN1467) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 22769) |
| Enumeration Date | 2019-09-11 |
| Last Update Date | 2025-09-02 |