| NPI | 1639151772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN696) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 15139) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2021-05-20 |