| NPI | 1194133504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: LA 312353) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL36703) |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2022-08-22 |