NPI | 1548480825 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN534) |
Additional Taxonomies | 208D00000X General Practice (Licence: PR 16424) |
Enumeration Date | 2007-04-27 |
Last Update Date | 2024-08-27 |