| NPI | 1497108393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1088) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19420) |
| Enumeration Date | 2016-07-15 |
| Last Update Date | 2023-05-10 |