| NPI | 1700904489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1325) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 16765) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2023-05-01 |