| NPI | 1306873971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 14402) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN1387) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2023-06-01 |