| NPI | 1992301881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1326) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 22106) |
| Enumeration Date | 2020-12-07 |
| Last Update Date | 2025-04-22 |