| NPI | 1861886608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN941) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19017) |
| Enumeration Date | 2015-03-18 |
| Last Update Date | 2019-09-16 |