| NPI | 1912103250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 15494) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2023-03-07 |