| NPI | 1770562308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 15444) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: PR 15444) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2017-06-28 |