| NPI | 1518202514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: HI DOS-830) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA OP00001090) |
| Enumeration Date | 2012-12-01 |
| Last Update Date | 2012-12-01 |