| NPI | 1710365697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282NR1301X General Acute Care Hospital, Rural |
| Additional Taxonomies | 208600000X Surgery (Licence: MD P31357) |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2022-07-25 |