| NPI | 1225397797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: OK 6831) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5315085034) |
| 208600000X Surgery (Licence: MI 5101019676) | |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2021-07-13 |