NPI | 1275656449 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: PR 16640) |
Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN258) |
Enumeration Date | 2007-04-10 |
Last Update Date | 2024-03-05 |