| NPI | 1033225388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA G64776) |
| Additional Taxonomies | 2082S0099X Plastic Surgery Plastic Surgery Within the Head and Neck (Licence: CA G64776) |
| 2082S0105X Plastic Surgery Surgery of the Hand (Licence: CA G64776) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2013-01-16 |