NPI | 1699908830 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN424) |
Additional Taxonomies | 208D00000X General Practice (Licence: PR 17719) |
Enumeration Date | 2009-09-03 |
Last Update Date | 2018-06-04 |