| NPI | 1518147552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 021155) |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: GA 021155) |
| Enumeration Date | 2007-11-07 |
| Last Update Date | 2011-11-22 |