| NPI | 1669630422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 5746) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN63) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2008-05-29 |