| NPI | 1326494394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: SC 92443) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN# 20822) |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2024-08-26 |