| NPI | 1285126060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MN 79827) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MO 2018018678) |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2025-07-02 |