| NPI | 1518187186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QU0200X Clinic/Center Urgent Care (Licence: CO 27554) |
| Additional Taxonomies | 2083X0100X Preventive Medicine Occupational Medicine (Licence: CO 27554) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2013-11-14 |