| NPI | 1184870925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 17189) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN425) |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2024-05-09 |