| NPI | 1801239439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN523) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME135096) |
| Enumeration Date | 2013-04-12 |
| Last Update Date | 2023-03-09 |