| NPI | 1124359088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: OR 13099) |
| Additional Taxonomies | 174H00000X Health Educator (Licence: VA YA#29243) |
| 174400000X Specialist (Licence: OR 512195-6) | |
| Enumeration Date | 2010-01-15 |
| Last Update Date | 2013-04-23 |