| NPI | 1174713184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN390) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 17506) |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2014-02-11 |