| NPI | 1750738316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: VA 0101260128) |
| Additional Taxonomies | 281P00000X Chronic Disease Hospital (Licence: VA 0101260128) |
| 282E00000X (Licence: VA 0101260128) | |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2016-05-24 |