| NPI | 1477964187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174H00000X Health Educator (Licence: NY 553847) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 553847) |
| Enumeration Date | 2014-05-15 |
| Last Update Date | 2014-05-15 |