| NPI | 1013144708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN323) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 17,611) |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2022-01-27 |