NPI | 1457458887 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN547) |
Additional Taxonomies | 208D00000X General Practice (Licence: PR 12816) |
Enumeration Date | 2006-09-20 |
Last Update Date | 2016-01-15 |