| NPI | 1174780811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: VA 0101-253023) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NC 128607) |
| 208600000X Surgery (Licence: VA 0101-253023) | |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2021-05-10 |