| NPI | 1730987595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1714) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 024277) |
| Enumeration Date | 2025-03-06 |
| Last Update Date | 2025-04-17 |