| NPI | 1528599933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX v9183) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125.071203) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2025-08-21 |