| NPI | 1386600351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-50388) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: AL 24664) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2025-03-25 |