| NPI | 1336432418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: CT 61697) |
| Additional Taxonomies | 208600000X Surgery (Licence: RI LP02221) |
| 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: RI LP02221) | |
| Enumeration Date | 2011-05-23 |
| Last Update Date | 2022-07-21 |