| NPI | 1790168920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN 725) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19115) |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2015-12-10 |