| NPI | 1699136606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 2355A2700X Specialist/Technologist, Audiology Assistant (Licence: FL AI473) |
| 173000000X Legal Medicine | |
| 171400000X Health & Wellness Coach | |
| 171M00000X Case Manager/Care Coordinator | |
| 106S00000X Behavior Technician | |
| 174H00000X Health Educator | |
| 251J00000X Nursing Care | |
| Enumeration Date | 2016-03-18 |
| Last Update Date | 2026-05-11 |