| NPI | 1700291010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN633) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 18767) |
| 208D00000X General Practice (Licence: FL acn663) | |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2024-01-22 |