| NPI | 1164452033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN 753) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PR 015689) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ACN 753) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2016-09-23 |