| NPI | 1235253253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: NV 13989) |
| Additional Taxonomies | 208600000X Surgery (Licence: NV 13989) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2023-03-07 |