| NPI | 1467859660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN693) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 18,942) |
| Enumeration Date | 2014-12-03 |
| Last Update Date | 2018-10-24 |