NPI | 1144547829 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C03440) |
Additional Taxonomies | 261QX0100X Clinic/Center, Occupational Medicine (Licence: MD C0003440) |
Enumeration Date | 2010-04-21 |
Last Update Date | 2024-07-10 |