| NPI | 1689652893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: TN 18775) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN 18775) |
| 174H00000X Health Educator (Licence: TN 18775) | |
| 101YS0200X Counselor, School (Licence: TN 18775) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2025-09-11 |