| NPI | 1194717868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 175757) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: NY 175757-1) |
| 207R00000X Internal Medicine (Licence: NY 175757) | |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2012-07-05 |