| NPI | 1417990763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN882) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 14531) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2016-12-28 |