| NPI | 1063777985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MI 4301112110) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R73514) |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2023-01-11 |