| NPI | 1225212442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A79125) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A79125) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WA MD60013998) | |
| Enumeration Date | 2007-12-24 |
| Last Update Date | 2019-04-02 |