| NPI | 1699797423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN505) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 14452) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2013-09-05 |