| NPI | 1447696315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN546) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 020572) |
| Enumeration Date | 2013-05-17 |
| Last Update Date | 2022-04-19 |