| NPI | 1902174782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A23118) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A23118) |
| Enumeration Date | 2011-12-07 |
| Last Update Date | 2011-12-07 |