| NPI | 1639170301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 25223-020) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant |
| 208600000X Surgery (Licence: WI 25223-020) | |
| 207P00000X Emergency Medicine (Licence: WI 25223) | |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2017-01-05 |