| NPI | 1235365800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AR E6215) |
| Additional Taxonomies | 282NR1301X General Acute Care Hospital, Rural |
| Enumeration Date | 2009-06-09 |
| Last Update Date | 2015-12-08 |