| NPI | 1346342656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN446) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 15572) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2019-10-28 |