| NPI | 1689073819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN675) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 18854) |
| Enumeration Date | 2014-08-13 |
| Last Update Date | 2024-06-18 |