| NPI | 1215085303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 13330) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: PR 13330) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2017-04-18 |