| NPI | 1174505929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN 353) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 12925) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2022-03-31 |