| NPI | 1952387961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN515) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 15975) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2016-10-27 |