| NPI | 1891926911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN978) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 17661) |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2023-03-07 |