| NPI | 1043335151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QX0100X Clinic/Center, Occupational Medicine (Licence: AL 5762) |
| Additional Taxonomies | 208600000X Surgery (Licence: AL 5762) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2019-04-15 |