| NPI | 1194004309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: CA 20A11848) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA 20A11848) |
| 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: TX Q3137) | |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2024-07-25 |