| NPI | 1073773180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: CA A115941) |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: FL ME108875) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2021-03-18 |