| NPI | 1639263676 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: GA 024863) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 024863) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2015-06-22 |