| NPI | 1316963358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QU0200X Clinic/Center Urgent Care (Licence: GA 047601) |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care (Licence: GA 047601) |
| 261QX0100X Clinic/Center Occupational Medicine (Licence: GA 047601) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2023-03-07 |