| NPI | 1386600187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN865) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 14902) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2026-01-06 |