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 | 2025-09-12 |