| NPI | 1255623567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A121818) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: CA A121818) |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2023-08-04 |