NPI | 1356705677 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN979) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 019299) |
208D00000X General Practice (Licence: PR 019299) | |
Enumeration Date | 2016-04-12 |
Last Update Date | 2023-01-25 |