| NPI | 1285604322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN-837) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 15000) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2017-11-15 |