| NPI | 1245624220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 12346972-1205) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: VA 0116031447) |
| 208600000X Surgery (Licence: FL TRN19445) | |
| 208D00000X General Practice (Licence: UT 12346972-1205) | |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2022-10-31 |