| NPI | 1972042950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1244) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2017-02-23 |
| Last Update Date | 2021-05-19 |