| NPI | 1790834539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 11526) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: PR 11526) |
| 282NC0060X General Acute Care Hospital, Critical Access (Licence: PR 11526) | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2019-03-25 |