| NPI | 1891945580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN587) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 17355) |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2016-09-01 |