| NPI | 1528266830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: WI 53821-21) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NJ none) |
| Enumeration Date | 2007-07-08 |
| Last Update Date | 2010-05-06 |