| NPI | 1629251004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: AZ 48754) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: AZ 48754) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A121163) | |
| Enumeration Date | 2007-12-09 |
| Last Update Date | 2019-11-07 |