| NPI | 1932259306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: CA G87853) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G87853) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2024-05-09 |