| NPI | 1962870741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1293) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 21143) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-09-10 |
| Last Update Date | 2023-10-26 |