| NPI | 1770991010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN715) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 18833) |
| Enumeration Date | 2014-07-31 |
| Last Update Date | 2022-08-12 |