| NPI | 1922066083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD446485) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: AL 22908) |
| 207P00000X Emergency Medicine (Licence: PA MD446485) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2013-04-25 |