| NPI | 1154372555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN918) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: PR 16139) |
| 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: PR 16139) | |
| 208D00000X General Practice (Licence: PR 16139) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2020-08-18 |