| NPI | 1306900097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: ID M-12099) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 1871) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2020-10-06 |