| NPI | 1295855823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: FL ME120069) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 94-05814) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A98342) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2019-01-29 |