| NPI | 1811167505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN776) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: PR 17039) |
| Enumeration Date | 2008-03-10 |
| Last Update Date | 2018-03-17 |