| NPI | 1689980435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 790710971) |
| Additional Taxonomies | 174H00000X Health Educator (Licence: NY 094425011) |
| Enumeration Date | 2010-08-30 |
| Last Update Date | 2012-06-08 |