| NPI | 1740928985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1603) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 023335) |
| Enumeration Date | 2022-05-26 |
| Last Update Date | 2025-05-15 |