| NPI | 1679926687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN907) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19415) |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2024-01-19 |