| NPI | 1235517996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA MT221196) |
| Additional Taxonomies | 208600000X Surgery (Licence: RI LP03325) |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2020-06-25 |