| NPI | 1235261660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN607) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 15994) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2023-03-07 |