NPI | 1982077392 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ACN957) |
Additional Taxonomies | 208D00000X General Practice (Licence: PR 19213) |
Enumeration Date | 2015-11-06 |
Last Update Date | 2019-08-20 |