| NPI | 1417193376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: MD D-48393) |
| Additional Taxonomies | 284300000X Special Hospital (Licence: MD D-48393) |
| Enumeration Date | 2008-12-24 |
| Last Update Date | 2008-12-24 |