| NPI | 1831682616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1173) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 14710-I) |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2020-05-25 |