| NPI | 1437244886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282NC0060X General Acute Care Hospital, Critical Access (Licence: IL 036-083997) |
| Additional Taxonomies | 282NC0060X General Acute Care Hospital, Critical Access (Licence: GA 038665) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2007-07-08 |