| NPI | 1164070330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1202) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 21549) |
| Enumeration Date | 2019-08-29 |
| Last Update Date | 2021-10-25 |