| NPI | 1043260458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C36975) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA C36975) |
| 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: CA C36975) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2023-01-13 |