| NPI | 1164563631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 22998) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OK 22998) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2019-04-09 |