| NPI | 1487605432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1044) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 15670) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2022-06-23 |