| NPI | 1124480611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MA 279398) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MA 279398) |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2023-06-27 |