NPI | 1245358969 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G080322) |
Additional Taxonomies | 208600000X Surgery (Licence: CA G080322) |
2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA G80322) | |
Enumeration Date | 2007-03-27 |
Last Update Date | 2014-11-05 |