| NPI | 1760763114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN994) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 018283) |
| Enumeration Date | 2011-08-30 |
| Last Update Date | 2020-02-24 |