| NPI | 1568461945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN987) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 12579) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2023-06-02 |