| NPI | 1962727859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: ME MD23080) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A119555) |
| 208600000X Surgery (Licence: CA A119555) | |
| Enumeration Date | 2010-04-02 |
| Last Update Date | 2019-06-03 |