| NPI | 1629561873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1078) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9257883) |
| 208D00000X General Practice (Licence: PR 19977) | |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2021-03-11 |