| NPI | 1548590631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: KY 46065) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: KY 46065) |
| 208600000X Surgery (Licence: KY 46065) | |
| Enumeration Date | 2010-01-12 |
| Last Update Date | 2018-06-27 |