| NPI | 1275544892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD23552) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: CA A80628) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2025-12-04 |