| NPI | 1811054901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN539) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 10493) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2019-09-20 |