| NPI | 1700296225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: DC MD16216) |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services (Licence: MS 08795) |
| Enumeration Date | 2014-05-06 |
| Last Update Date | 2014-05-06 |