| NPI | 1679916092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WA MD60577638) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA ML60370499) |
| 208600000X Surgery (Licence: WA MD60577638) | |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2021-06-03 |