| NPI | 1467596536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 14637) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 4301113536) |
| 208D00000X General Practice (Licence: FL ACN883) | |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2024-04-17 |