| 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 |