| NPI | 1437353703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1451) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PR 16798) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2023-06-01 |