| NPI | 1952575342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A95627) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A95627) |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2020-07-06 |