| NPI | 1730417312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN 521) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 17791) |
| Enumeration Date | 2009-11-19 |
| Last Update Date | 2024-05-17 |