| NPI | 1144664970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX U3891) |
| Additional Taxonomies | 208600000X Surgery (Licence: OK 29829) |
| Enumeration Date | 2013-04-23 |
| Last Update Date | 2023-08-01 |