| NPI | 1689645491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics Adolescent Medicine (Licence: NC 25046) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: PA MD443468) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2017-01-11 |