| NPI | 1386052967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA a135579) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A135579) |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2022-07-22 |