| NPI | 1922827641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP0905X Clinic/Center, Public Health, State or Local |
| Additional Taxonomies | 251K00000X Public Health or Welfare |
| Enumeration Date | 2024-10-09 |
| Last Update Date | 2024-10-09 |