NPI | 1194827600 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN844) |
Additional Taxonomies | 101Y00000X Counselor (Licence: FL CI 487) |
208D00000X General Practice (Licence: PR 019308) | |
Enumeration Date | 2006-09-04 |
Last Update Date | 2023-07-05 |