| NPI | 1467779579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN667) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 17894) |
| Enumeration Date | 2010-04-28 |
| Last Update Date | 2024-08-27 |