| NPI | 1255475331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN427) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 15498) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2015-01-05 |