| NPI | 1861717647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A130163) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NC 2017-00114) |
| Enumeration Date | 2010-04-05 |
| Last Update Date | 2022-07-21 |