| NPI | 1386323012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2023022067) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MO 2023022067) |
| Enumeration Date | 2023-07-11 |
| Last Update Date | 2025-08-11 |