| NPI | 1174884811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX Q2962) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MN 106074) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MN 55835) | |
| Enumeration Date | 2012-05-30 |
| Last Update Date | 2020-12-04 |