| NPI | 1275986903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 2470A2800X Technician, Health Information, Assistant Record Technician |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2016-07-18 |