NPI | 1912106071 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN270) |
Additional Taxonomies | 208D00000X General Practice (Licence: PR 16108) |
Enumeration Date | 2007-07-17 |
Last Update Date | 2024-12-10 |