| NPI | 1245558816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: TX 203793) |
| Additional Taxonomies | 174H00000X Health Educator (Licence: TX 203793) |
| Enumeration Date | 2010-05-06 |
| Last Update Date | 2010-05-06 |