| NPI | 1154388866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 9601723) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: NC 96-01723) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2024-01-08 |