| NPI | 1972721330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN779) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PR 7005) |
| 208D00000X General Practice (Licence: PR 7005) | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2021-08-03 |