NPI | 1811167505 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN776) |
Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: PR 17039) |
Enumeration Date | 2008-03-10 |
Last Update Date | 2018-03-17 |