| NPI | 1558743021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QX0100X Clinic/Center, Occupational Medicine (Licence: FL OT 17076) |
| Additional Taxonomies | 261QX0100X Clinic/Center, Occupational Medicine (Licence: CA OT 14996) |
| 261QX0100X Clinic/Center, Occupational Medicine (Licence: LA OTT.200727) | |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2015-06-22 |