| NPI | 1396034476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301510082) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MI 4301510082) |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2025-06-02 |