| NPI | 1730157322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 14524) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: IA 17368) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2007-07-09 |