| NPI | 1326425059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: SC 89538) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101021609) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MI 5151010443) | |
| Enumeration Date | 2015-05-01 |
| Last Update Date | 2026-09-02 |