| NPI | 1730140377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN740) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 15590) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2025-01-17 |