| NPI | 1609489624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 405300000X Prevention Professional (Licence: OH OCPSA.161826) |
| Additional Taxonomies | 405300000X Prevention Professional (Licence: OH RA.162173) |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2023-01-05 |