| NPI | 1992048110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 01033001272) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MD 01627) |
| 208200000X Plastic Surgery (Licence: DC PO1000133) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: DC PO1000133) | |
| Enumeration Date | 2013-04-05 |
| Last Update Date | 2020-11-24 |