| NPI | 1285096669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN859) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19280) |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2018-07-16 |