| NPI | 1144460684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN567) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 17442) |
| Enumeration Date | 2009-02-24 |
| Last Update Date | 2026-03-12 |