| NPI | 1003006602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: MS 21406) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MS 21406) |
| 208600000X Surgery (Licence: LA MD200014) | |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2020-08-11 |