| NPI | 1225227051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN532) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 16894) |
| Enumeration Date | 2007-10-17 |
| Last Update Date | 2018-03-27 |