| NPI | 1336474816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: WA md00028278) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA md00028278) |
| Enumeration Date | 2009-10-16 |
| Last Update Date | 2009-10-16 |