| NPI | 1972917771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN749) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 18834) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2023-09-18 |