| NPI | 1306042254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: SC 36140) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MO 2007018104) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2018-07-18 |