| NPI | 1801078159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA C170505) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: LA 026278) |
| 208600000X Surgery (Licence: CA C170505) | |
| 208600000X Surgery (Licence: LA 026278) | |
| Enumeration Date | 2007-11-28 |
| Last Update Date | 2026-07-16 |