| NPI | 1508824616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QH0002X Family Medicine Hospice and Palliative Medicine (Licence: OR MD156287) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX J2037) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2020-02-25 |