| NPI | 1275945172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN579) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 018708) |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2025-08-27 |