| NPI | 1952013021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1651) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 16494I) |
| Enumeration Date | 2022-12-20 |
| Last Update Date | 2024-09-09 |