| NPI | 1902913106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QX0100X Clinic/Center, Occupational Medicine (Licence: OR MD18309) |
| Additional Taxonomies | 261QX0100X Clinic/Center, Occupational Medicine (Licence: WA MD00026280) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2007-07-08 |