| NPI | 1770700429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: FL ME110935) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A90547) |
| 208200000X Plastic Surgery (Licence: FL ME110935) | |
| 208600000X Surgery (Licence: CA A90547) | |
| 208600000X Surgery (Licence: FL ME110935) | |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2015-08-06 |