| NPI | 1649651274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME138986) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN668) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2022-09-14 |