NPI | 1992235881 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ACN1158) |
Additional Taxonomies | 208D00000X General Practice (Licence: PR 14184-I) |
Enumeration Date | 2017-06-14 |
Last Update Date | 2022-04-11 |