| NPI | 1255837696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: KY 18215) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 202C00000X Independent Medical Examiner (Licence: KY 18215) | |
| 208D00000X General Practice (Licence: KY 18215) | |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2018-04-04 |