NPI | 1417203126 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: HI DOS-1564) |
Additional Taxonomies | 208D00000X General Practice (Licence: WA OP 60428780) |
Enumeration Date | 2012-07-31 |
Last Update Date | 2017-03-29 |