| NPI | 1790768059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1089) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 14882) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2022-07-11 |