| NPI | 1720302722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 173000000X Legal Medicine (Licence: NY 118615) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: NY 118615) |
| Enumeration Date | 2010-03-18 |
| Last Update Date | 2010-03-18 |