| NPI | 1801848478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN247) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 15486) |
| 208D00000X General Practice (Licence: MI 4301113879) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2024-10-02 |