| NPI | 1720523996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251K00000X Public Health or Welfare (Licence: DC MD12369) |
| Additional Taxonomies | 251S00000X (Licence: DC MD12369) |
| Enumeration Date | 2016-12-27 |
| Last Update Date | 2016-12-27 |