| NPI | 1558400341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 18952) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TN 25312) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2011-06-21 |