NPI | 1013014281 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN775) |
Additional Taxonomies | 208D00000X General Practice (Licence: PR 12396) |
Enumeration Date | 2006-09-20 |
Last Update Date | 2019-05-07 |