| NPI | 1932853074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1555) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 023176) |
| Enumeration Date | 2022-02-08 |
| Last Update Date | 2025-01-17 |