| NPI | 1902816259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN243) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 13350) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2019-01-29 |