| NPI | 1851985642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1436) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 022289) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-02-23 |
| Last Update Date | 2022-06-07 |