| NPI | 1902899271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: NC 9600787) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 96-00787) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2012-02-23 |