NPI | 1205951175 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN383) |
Additional Taxonomies | 208D00000X General Practice (Licence: PR 12612) |
Enumeration Date | 2007-03-20 |
Last Update Date | 2024-06-05 |