| NPI | 1033305602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A92111) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A92111) |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2025-07-28 |