| NPI | 1558773937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WA 60903199) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA 60469953) |
| Enumeration Date | 2014-05-20 |
| Last Update Date | 2018-11-19 |