| NPI | 1689605180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care (Licence: CA A064065) |
| Additional Taxonomies | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: CA A064065) |
| 208D00000X General Practice (Licence: CA A064065) | |
| 209800000X Legal Medicine (Licence: CA A064065) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2020-12-16 |