| NPI | 1811908502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN931) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 12658) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2019-12-12 |