NPI | 1477263937 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1614) |
Additional Taxonomies | 208D00000X General Practice (Licence: PR 14610-I) |
208D00000X General Practice (Licence: PR 023146) | |
Enumeration Date | 2022-11-24 |
Last Update Date | 2024-06-24 |