| NPI | 1053354738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1252) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 13389) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2020-10-21 |