| NPI | 1184797482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ACN916) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN916) |
| 208D00000X General Practice (Licence: PR 15988) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2026-07-20 |