| NPI | 1154351971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 33357) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: WV 21904) |
| 174400000X Specialist (Licence: WV 21904) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2009-12-14 |