| NPI | 1578637013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine (Licence: SC 17639) |
| Additional Taxonomies | 146M00000X Emergency Medical Technician, Intermediate (Licence: SC HTL-098) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2010-02-23 |