| NPI | 1861747826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MA 282107) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 282107) |
| 208200000X Plastic Surgery (Licence: MA 282107) | |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2022-09-22 |