| NPI | 1922076470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 39327) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: KY 39327) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: KY 39327) | |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2016-02-12 |