| NPI | 1891441010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1680) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 22628) |
| Enumeration Date | 2022-02-25 |
| Last Update Date | 2024-12-23 |