| NPI | 1497580203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: MS 40287) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MS 40287) |
| 174H00000X Health Educator (Licence: MS 40287) | |
| Enumeration Date | 2024-09-03 |
| Last Update Date | 2024-11-12 |