| NPI | 1760753388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 284300000X Special Hospital (Licence: TX M1000) |
| Additional Taxonomies | 281P00000X Chronic Disease Hospital (Licence: TX M1000) |
| 282N00000X General Acute Care Hospital (Licence: TX M1000) | |
| 282N00000X General Acute Care Hospital (Licence: MN 39292) | |
| 282N00000X General Acute Care Hospital (Licence: CA C55003) | |
| 282N00000X General Acute Care Hospital (Licence: CA c550003) | |
| Enumeration Date | 2012-01-13 |
| Last Update Date | 2012-09-04 |