| NPI | 1053967638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1279) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ACN1279) |
| 208D00000X General Practice (Licence: PR 21520) | |
| Enumeration Date | 2019-08-10 |
| Last Update Date | 2021-08-10 |