| 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 |