| NPI | 1215058359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NM MD2009-0440) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MI 4301075872) |
| 208200000X Plastic Surgery (Licence: CA A 96895) | |
| 208200000X Plastic Surgery (Licence: NM MD2009-0440) | |
| 208600000X Surgery (Licence: MI 4301075872) | |
| 208600000X Surgery (Licence: CA A 96895) | |
| 208600000X Surgery (Licence: NM MD2009-0440) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A 96895) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2017-03-22 |