| NPI | 1548648561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN720) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 019124) |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2023-12-01 |