| NPI | 1992305197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1404) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 22011) |
| Enumeration Date | 2020-10-27 |
| Last Update Date | 2021-12-17 |