| NPI | 1134325012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301090356) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: AZ 45896) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2020-01-29 |