| NPI | 1841214996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 14396) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN516) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2018-05-24 |