| NPI | 1720024417 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G89167) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: PA MD048553L) |
| 2082S0105X Plastic Surgery, Surgery of the Hand (Licence: PA MD048553L) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA MD048553L) | |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2024-02-06 |