| NPI | 1265060875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101276298) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN1487) |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2024-02-29 |