| NPI | 1275945172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN579) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 579) |
| 207Q00000X Family Medicine (Licence: FL ACN579) | |
| 207Q00000X Family Medicine (Licence: PR 018708) | |
| 208D00000X General Practice (Licence: PR 018708) | |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2022-08-12 |