| NPI | 1235439373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN854) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 18068) |
| Enumeration Date | 2010-10-22 |
| Last Update Date | 2022-07-21 |