NPI | 1093187064 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1266) |
Additional Taxonomies | 208D00000X General Practice (Licence: PR 18965) |
Enumeration Date | 2015-10-29 |
Last Update Date | 2021-01-18 |