| NPI | 1942758339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1118) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: PR 19476) |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2019-11-06 |