| NPI | 1659514321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: WA OP61424846) |
| Additional Taxonomies | 208D00000X General Practice (Licence: HI DOS-1255) |
| 208600000X Surgery (Licence: TX Q9926) | |
| 208600000X Surgery (Licence: WA OP61424846) | |
| 2086S0129X (Licence: TX Q9926) | |
| Enumeration Date | 2009-04-10 |
| Last Update Date | 2025-11-20 |