| NPI | 1942307186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1305) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ACN1305) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2022-01-26 |