| NPI | 1235340308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: CA A96161) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: CA A96161) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2008-07-09 |