| NPI | 1447451042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX Q6474) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN11017) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: AZ 46314) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2023-08-24 |