NPI | 1780451922 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1724) |
Additional Taxonomies | 208D00000X General Practice (Licence: PR 16589I) |
Enumeration Date | 2023-12-07 |
Last Update Date | 2025-06-09 |