| NPI | 1518450311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL acn1176) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 21410) |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2020-01-30 |