| NPI | 1467429381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: CA 20A19266) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0102201363) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2022-08-17 |