NPI | 1801194147 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: FL ME134861) |
Additional Taxonomies | 208D00000X General Practice (Licence: PR 18,145) |
208D00000X General Practice (Licence: FL ACN395) | |
Enumeration Date | 2011-03-10 |
Last Update Date | 2020-05-12 |