| NPI | 1720101900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN 259) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 16642) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2015-09-29 |