| NPI | 1396158648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: CA A143928) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A143928) |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2024-09-25 |