| 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 |