| NPI | 1790794667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: GA 046795) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: GA 046795) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2007-07-08 |