| NPI | 1780119727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1015) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19713) |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2024-02-27 |