| NPI | 1992925937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN 263) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 14557) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2013-01-29 |