| NPI | 1467213769 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PR 6137468) |
| Additional Taxonomies | 174H00000X Health Educator (Licence: PR 6137468) |
| Enumeration Date | 2024-01-23 |
| Last Update Date | 2024-01-24 |