| NPI | 1699938456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282NR1301X General Acute Care Hospital, Rural (Licence: WY 8745A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 5794) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2011-12-28 |