| NPI | 1477608214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QX0100X Clinic/Center, Occupational Medicine (Licence: TN 019916) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN MD19916) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2010-02-18 |