| NPI | 1386056547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: CA A186811) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0116026740) |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2024-03-18 |