| NPI | 1699908830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN424) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 17719) |
| Enumeration Date | 2009-09-03 |
| Last Update Date | 2018-06-04 |