| NPI | 1962051235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2470A2800X Technician, Health Information, Assistant Record Technician |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2019-09-09 |
| Last Update Date | 2020-09-25 |