| NPI | 1881181394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1631) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 23147) |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2025-07-01 |