| NPI | 1750014601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1553) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 23407) |
| Enumeration Date | 2022-07-07 |
| Last Update Date | 2023-08-18 |