| NPI | 1902197445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 18678) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN943) |
| Enumeration Date | 2011-05-02 |
| Last Update Date | 2017-10-10 |