| NPI | 1386919777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: PA MD469565) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2012-03-19 |
| Last Update Date | 2022-02-22 |