NPI | 1053969691 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1248) |
Additional Taxonomies | 208D00000X General Practice (Licence: PR 021528) |
Enumeration Date | 2019-08-27 |
Last Update Date | 2023-02-02 |