| NPI | 1881085827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN869) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 13724-I) |
| Enumeration Date | 2015-02-12 |
| Last Update Date | 2023-06-05 |