| NPI | 1144979857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 22965) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN1483) |
| Enumeration Date | 2022-03-21 |
| Last Update Date | 2022-10-04 |