| NPI | 1649557059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME163130) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN - 752) |
| 208D00000X General Practice (Licence: PR 020989) | |
| Enumeration Date | 2011-11-14 |
| Last Update Date | 2024-01-23 |