| NPI | 1811971609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN623) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 14674) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2024-05-17 |