| NPI | 1376526277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 21190) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: IA 21190) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2008-10-22 |