| NPI | 1356675177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: TN MD5522) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: TN MD5522) |
| Enumeration Date | 2009-09-25 |
| Last Update Date | 2009-09-25 |