| NPI | 1437314879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN56) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA 21215) |
| 208D00000X General Practice (Licence: LA 07907R) | |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2008-07-24 |