| NPI | 1164466876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN928) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 16200) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2022-09-27 |