| NPI | 1811347511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA 20A22729) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS021193) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2024-08-08 |