| NPI | 1689157539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1199) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 21098) |
| Enumeration Date | 2018-09-06 |
| Last Update Date | 2023-09-12 |