| NPI | 1952081390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 23336) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN1732) |
| Enumeration Date | 2023-07-20 |
| Last Update Date | 2025-12-18 |