| NPI | 1235175902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: CA G34668) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA G34668) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2021-04-11 |