| NPI | 1932728557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1473) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 21874) |
| Enumeration Date | 2020-04-14 |
| Last Update Date | 2024-08-14 |