| NPI | 1306820899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 60410) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MA 60410) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2018-03-17 |