NPI | 1306270509 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1047) |
Additional Taxonomies | 208D00000X General Practice (Licence: PR 15442) |
Enumeration Date | 2013-08-25 |
Last Update Date | 2023-03-07 |