NPI | 1902258833 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: MD D0079396) |
Additional Taxonomies | 261QH0100X Clinic/Center, Health Services (Licence: SC 34187) |
261QH0100X Clinic/Center, Health Services (Licence: MO 2013002834) | |
261QH0100X Clinic/Center, Health Services (Licence: PA MD444912) | |
261QH0100X Clinic/Center, Health Services (Licence: AL 17009) | |
Enumeration Date | 2016-07-03 |
Last Update Date | 2017-04-21 |