| NPI | 1912219809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 54772) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: MN 54722) |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2022-06-29 |