| NPI | 1104804269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: KY 43244) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: KY 43244) |
| 208200000X Plastic Surgery (Licence: OR MD26282) | |
| 208600000X Surgery (Licence: KY 43244) | |
| Enumeration Date | 2006-01-08 |
| Last Update Date | 2022-02-01 |