| NPI | 1407092877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1542) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 17427) |
| Enumeration Date | 2009-01-06 |
| Last Update Date | 2023-07-31 |