| NPI | 1710088620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ACN369) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 069487) |
| 207Q00000X Family Medicine (Licence: MI 4301109006) | |
| 208D00000X General Practice (Licence: PR 16311) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2018-01-03 |