| NPI | 1992404677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1578) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 23123) |
| 208D00000X General Practice (Licence: FL 1578) | |
| Enumeration Date | 2023-03-01 |
| Last Update Date | 2024-01-03 |