| NPI | 1629578604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital |
| Additional Taxonomies | 273R00000X Psychiatric Unit |
| 281P00000X Chronic Disease Hospital | |
| Enumeration Date | 2018-02-16 |
| Last Update Date | 2018-02-16 |