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 |