| 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 |