| NPI | 1437399730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1067) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 17490) |
| Enumeration Date | 2009-02-26 |
| Last Update Date | 2020-01-29 |