| NPI | 1750569042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL acn666) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 16995) |
| Enumeration Date | 2008-02-08 |
| Last Update Date | 2024-08-05 |