| NPI | 1114948874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 21104) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PR 194) |
| 207P00000X Emergency Medicine (Licence: PR 21104) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2021-10-25 |