| NPI | 1194906867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: FL ME99719) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME99719) |
| Enumeration Date | 2007-11-21 |
| Last Update Date | 2007-11-21 |