| NPI | 1104068584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN336) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 17750) |
| Enumeration Date | 2009-03-31 |
| Last Update Date | 2018-03-17 |