| NPI | 1104292846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN683) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 18959) |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2017-01-11 |