| NPI | 1801684501 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 174H00000X Health Educator | 
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator | 
| 246Y00000X Spec/Tech, Health Info | |
| Enumeration Date | 2025-04-30 | 
| Last Update Date | 2025-04-30 |