| NPI | 1265585939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: FL ME124629) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT049106T) |
| 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: CT 047323) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2022-11-21 |