| NPI | 1801188677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1673) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 17982) |
| Enumeration Date | 2011-05-11 |
| Last Update Date | 2025-03-27 |