| NPI | 1255698619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN634) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX bp10043366) |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2016-01-20 |