| NPI | 1770346199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1744) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 24560) |
| Enumeration Date | 2024-01-31 |
| Last Update Date | 2025-12-23 |