| NPI | 1497194567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: KY 54706) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MO 2019010349) |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2025-07-16 |