| NPI | 1770512915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 37012) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: CT 037012) |
| 207P00000X Emergency Medicine (Licence: NY 290191) | |
| 207P00000X Emergency Medicine (Licence: CT 037012) | |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2021-11-04 |