| NPI | 1073006086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service |
| Additional Taxonomies | 174H00000X Health Educator |
| 247000000X Technician, Health Information | |
| 261QC1800X Clinic/Center Corporate Health | |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2018-06-13 |