| NPI | 1255354841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN800) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: FL ACN800) |
| 208D00000X General Practice (Licence: PR 15643) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2022-02-22 |