NPI | 1710911243 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN563) |
Additional Taxonomies | 208D00000X General Practice (Licence: PR 13942) |
Enumeration Date | 2006-07-10 |
Last Update Date | 2023-03-07 |