| NPI | 1801198791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN688) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 18095) |
| Enumeration Date | 2010-11-26 |
| Last Update Date | 2015-10-05 |