| NPI | 1700073772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care (Licence: CA A101847) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CA A101847) |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2015-03-27 |