| NPI | 1003205519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN981) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19501) |
| Enumeration Date | 2015-01-21 |
| Last Update Date | 2026-05-01 |