| NPI | 1811918741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A83721) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA a83721) |
| 208600000X Surgery (Licence: CA a83721) | |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2012-09-29 |