| NPI | 1679946982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN806) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 019206) |
| Enumeration Date | 2015-11-09 |
| Last Update Date | 2019-10-08 |