| NPI | 1013951797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN452) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 14272) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2023-05-02 |