| NPI | 1144617382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN723) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19123) |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2023-06-01 |