| NPI | 1871244848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1552) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 15705i) |
| Enumeration Date | 2022-01-12 |
| Last Update Date | 2023-08-25 |