| NPI | 1124255666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: MO 2015022839) |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: MO 2009) |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2024-10-09 |