| NPI | 1053305458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A37323) |
| Additional Taxonomies | 261QX0100X Clinic/Center, Occupational Medicine (Licence: CA A37323) |
| 207L00000X Anesthesiology (Licence: CA A37323) | |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2021-05-13 |