| NPI | 1164619367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN904) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 16908) |
| Enumeration Date | 2007-10-02 |
| Last Update Date | 2018-04-09 |