| NPI | 1376151472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1489) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 021723) |
| Enumeration Date | 2020-07-15 |
| Last Update Date | 2023-01-06 |