| NPI | 1700824828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA C55493) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 024942) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: LA 024942) | |
| 208200000X Plastic Surgery (Licence: LA 024942) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2013-08-15 |