| NPI | 1881684660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN682) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 16201) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2025-03-10 |