| NPI | 1366874968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MI 4301103850) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301103850) |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2021-07-02 |