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 |