| NPI | 1831489517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 1408) |
| Additional Taxonomies | 2083X0100X Preventive Medicine Occupational Medicine (Licence: NE 1408) |
| Enumeration Date | 2011-04-14 |
| Last Update Date | 2013-12-18 |