| NPI | 1891127494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN472) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 18432) |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2018-01-26 |