| NPI | 1811297534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 18081) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN1516) |
| Enumeration Date | 2010-10-28 |
| Last Update Date | 2025-03-10 |