| NPI | 1336365246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 013581) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN797) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2024-04-01 |