| NPI | 1144427790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: GA 057880) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: GA 057880) |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2009-03-05 |