| NPI | 1407906076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN234) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ACN234) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2025-10-24 |