| NPI | 1801991054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN971) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 10777) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2019-02-04 |