| NPI | 1043574288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MA 264727) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 253071) |
| 208600000X Surgery (Licence: MA 264727) | |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2023-12-01 |