| NPI | 1275761975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN958) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 17642) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2017-10-11 |