NPI | 1699104265 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1095) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9298166) |
Enumeration Date | 2013-11-05 |
Last Update Date | 2021-12-16 |