| NPI | 1477673598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 20A7188) |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: CA 20A7188) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2007-07-08 |