| NPI | 1104272335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN891) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19424) |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2021-12-02 |