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 |