| NPI | 1598976557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN501) |
| Additional Taxonomies | 311Z00000X Custodial Care Facility (Licence: FL ACN501) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2022-04-07 |