| NPI | 1477933984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 19,069) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN758) |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2024-04-29 |