| NPI | 1134408487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1334) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS M061101) |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2021-07-19 |