| NPI | 1669453395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: CA 20A7129) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA 20A7129) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2019-10-28 |