| NPI | 1659935369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1183) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 21470) |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2024-01-17 |