| NPI | 1518117035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 17332) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ACN518) |
| Enumeration Date | 2008-09-19 |
| Last Update Date | 2014-10-21 |