| NPI | 1932567567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN950) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19252) |
| Enumeration Date | 2016-02-10 |
| Last Update Date | 2022-03-10 |