| NPI | 1093187064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1266) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 18965) |
| Enumeration Date | 2015-10-29 |
| Last Update Date | 2021-01-18 |