| NPI | 1700149143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN628) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 18847) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2017-10-30 |