| NPI | 1750522298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN289) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: FL ACN289) |
| Enumeration Date | 2009-03-12 |
| Last Update Date | 2020-08-23 |