| NPI | 1023105509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301083765) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: OH 35084098) |
| 207P00000X Emergency Medicine (Licence: OH 35084098) | |
| 207R00000X Internal Medicine (Licence: MI 4301083765) | |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2019-08-15 |