| NPI | 1760701528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: WA 15957) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00015957) |
| Enumeration Date | 2010-05-19 |
| Last Update Date | 2018-01-31 |