| NPI | 1790759595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 15130) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: PR 15130) |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2024-08-16 |