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