| NPI | 1770512915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 202K00000X Phlebology (Licence: SC 97514) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 037012) |
| 146D00000X Personal Emergency Response Attendant (Licence: CT 037012) | |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2026-09-11 |