| NPI | 1306087713 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN681) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 17398) |
| Enumeration Date | 2009-03-13 |
| Last Update Date | 2022-11-16 |