| NPI | 1942703525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1300) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ACN1300) |
| 208D00000X General Practice (Licence: PR 21918) | |
| Enumeration Date | 2018-03-09 |
| Last Update Date | 2023-02-07 |