| NPI | 1609819564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: NC 100540) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 100540) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2007-07-08 |