| NPI | 1215283908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN848) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL me159219) |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2025-02-22 |