| NPI | 1033460407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: MA S55651656) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: MA S55651656) |
| 174400000X Specialist | |
| Enumeration Date | 2012-09-26 |
| Last Update Date | 2012-09-26 |