| NPI | 1114297868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 18466) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN1001) |
| Enumeration Date | 2012-01-11 |
| Last Update Date | 2023-10-20 |