| NPI | 1336209345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: OR MD26066) |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: CA GO78756) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2024-03-19 |