| NPI | 1063123016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: TN 68111) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA 478246) |
| Enumeration Date | 2022-12-12 |
| Last Update Date | 2024-02-12 |