| NPI | 1013053438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA G076663) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA G076663) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA G076663) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2025-09-11 |