| NPI | 1245697218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN 841) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 019240) |
| Enumeration Date | 2016-01-21 |
| Last Update Date | 2026-06-03 |