| NPI | 1174592695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN591) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 15505) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2020-12-29 |