| NPI | 1679735393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX Q6933) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA R-8300) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2016-06-15 |