| NPI | 1427370857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: VA 0121000627) |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service (Licence: MD U01778) |
| Enumeration Date | 2010-02-26 |
| Last Update Date | 2023-07-21 |