| NPI | 1831320357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN330) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 017665) |
| Enumeration Date | 2009-07-31 |
| Last Update Date | 2013-04-17 |