| NPI | 1497194633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174H00000X Health Educator (Licence: OR MD08437) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR md08437) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2014-04-01 |