| NPI | 1093540775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: DC 0000) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: DC 0000) |
| 103TF0200X Psychologist Forensic (Licence: DC 0000) | |
| 104100000X Social Worker (Licence: DC 00000) | |
| 122300000X Dentist (Licence: DC 0000) | |
| 133N00000X Nutritionist (Licence: DC 00000) | |
| 146L00000X Emergency Medical Technician, Paramedic (Licence: DC 0000) | |
| 152W00000X Optometrist (Licence: DC 0000) | |
| 171W00000X Contractor (Licence: DC 0000) | |
| 1744R1102X Specialist Research Study (Licence: DC 0000) | |
| 207P00000X Emergency Medicine (Licence: DC 00000) | |
| 207Q00000X Family Medicine (Licence: DC 0000) | |
| 207U00000X Nuclear Medicine (Licence: DC 0000) | |
| 225700000X Massage Therapist (Licence: DC 0000) | |
| 405300000X Prevention Professional (Licence: DC 0000) | |
| Enumeration Date | 2024-09-03 |
| Last Update Date | 2024-09-03 |