| NPI | 1467025627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 023217) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PR 1466) |
| 374U00000X Home Health Aide (Licence: PR 15850-I) | |
| Enumeration Date | 2021-07-23 |
| Last Update Date | 2023-05-11 |