| NPI | 1780616656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 14953) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN639) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2016-12-07 |