| NPI | 1396990461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN447) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 17349) |
| Enumeration Date | 2008-11-17 |
| Last Update Date | 2024-10-01 |