| NPI | 1598815763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1251) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 15299) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2020-10-12 |