| NPI | 1164726667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN808) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 18116) |
| Enumeration Date | 2010-12-27 |
| Last Update Date | 2023-03-07 |