| NPI | 1053408872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME100079) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2015-01079) |
| 146D00000X Personal Emergency Response Attendant (Licence: OH 35058998P) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2022-01-20 |