| NPI | 1174901565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 1020503) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MI 4301504755) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MA 1020503) | |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2024-09-20 |