| NPI | 1922158476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1414) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ACN1414) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2024-08-27 |