| NPI | 1770176877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1343) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 22160) |
| Enumeration Date | 2021-02-19 |
| Last Update Date | 2024-02-14 |