| NPI | 1528425840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0102204942) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: NY 356555) |
| Enumeration Date | 2016-01-16 |
| Last Update Date | 2019-01-03 |