| NPI | 1184133050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN980) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19770) |
| Enumeration Date | 2017-09-23 |
| Last Update Date | 2024-03-05 |