| NPI | 1558596866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A141702) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D0072457) |
| 208600000X Surgery (Licence: CA A141702) | |
| Enumeration Date | 2009-05-16 |
| Last Update Date | 2020-09-17 |