| NPI | 1992235881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ACN1158) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 14184-I) |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2022-04-11 |