| NPI | 1518168814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VT 042.0012128) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: OR MD21838) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2014-05-20 |