| NPI | 1417330432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A036884) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A036884) |
| 207QB0002X Family Medicine, Bariatric Medicine (Licence: CA A036884) | |
| 208200000X Plastic Surgery (Licence: CA A036884) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: CA A036884) | |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2015-07-08 |