| NPI | 1851709554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 39188) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant |
| 207Q00000X Family Medicine (Licence: WI 62618-20) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 62618-20) | |
| Enumeration Date | 2014-07-25 |
| Last Update Date | 2023-08-23 |