| NPI | 1376754382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME70006) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: FL ME70006) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2016-03-03 |