| NPI | 1215425087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 405300000X Prevention Professional (Licence: OH OCPSA.4551) |
| Additional Taxonomies | 405300000X Prevention Professional (Licence: OH CDCA.165250) |
| Enumeration Date | 2018-04-27 |
| Last Update Date | 2018-04-27 |