| NPI | 1720280563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: FL ME110472) |
| Additional Taxonomies | 208600000X Surgery (Licence: PR 25908) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MA 247898) | |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2015-04-22 |