| NPI | 1063643138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN747) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 17695) |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2021-01-07 |