| NPI | 1891828547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA G45066) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G45066) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2026-04-06 |