| NPI | 1073763561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN983) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 17320) |
| Enumeration Date | 2008-09-22 |
| Last Update Date | 2022-03-22 |