| NPI | 1629466727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN836) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ACN836) |
| 208D00000X General Practice (Licence: PR 18979) | |
| Enumeration Date | 2014-12-26 |
| Last Update Date | 2020-11-12 |