| NPI | 1144251836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NC 2016-01507) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA OS014740) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2024-04-24 |