| NPI | 1568676922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN313) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 16097) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2010-09-14 |