| NPI | 1417264474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QR1100X Clinic/Center, Research | |
| Enumeration Date | 2010-09-10 |
| Last Update Date | 2010-09-10 |