| NPI | 1316940943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1208) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 11202) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2026-01-13 |