| NPI | 1669545992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: OK 9883) |
| Additional Taxonomies | 282E00000X Long Term Care Hospital (Licence: OK 9883) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2007-07-08 |