| 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 | 2026-09-11 |