| NPI | 1215314737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN707) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 13551-I) |
| Enumeration Date | 2015-05-05 |
| Last Update Date | 2018-07-05 |