| NPI | 1003230228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 405300000X Prevention Professional (Licence: OH 0004232) |
| Additional Taxonomies | 174H00000X Health Educator (Licence: OH TF699938) |
| Enumeration Date | 2014-02-07 |
| Last Update Date | 2017-02-01 |