| NPI | 1396199303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1144) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19320) |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2024-07-23 |