| NPI | 1992037121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 17816) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN343) |
| Enumeration Date | 2010-02-15 |
| Last Update Date | 2024-07-05 |