| NPI | 1881991743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301092329) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: MS 21671) |
| Enumeration Date | 2011-02-11 |
| Last Update Date | 2011-10-26 |