| NPI | 1205828647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX D4315) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: TX D4315) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2018-03-14 |