| NPI | 1205491628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA MT237179) |
| Additional Taxonomies | 208600000X Surgery (Licence: SD 0606) |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2026-05-14 |