| NPI | 1609127307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN 946) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 20004) |
| Enumeration Date | 2012-09-21 |
| Last Update Date | 2016-03-21 |