NPI | 1588075774 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN680) |
Additional Taxonomies | 208D00000X General Practice (Licence: PR 18665) |
Enumeration Date | 2014-05-11 |
Last Update Date | 2024-01-18 |