| NPI | 1962981282 |
|---|---|
| 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 | 2018-08-08 |
| Last Update Date | 2018-08-10 |