| NPI | 1902843063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34005589) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: OH 34005589) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2012-03-22 |