| NPI | 1316614241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 405300000X Prevention Professional (Licence: SD 0823) |
| Additional Taxonomies | 208D00000X General Practice (Licence: SD 0823) |
| 251K00000X Public Health or Welfare (Licence: SD 0823) | |
| Enumeration Date | 2021-08-27 |
| Last Update Date | 2021-08-27 |