| NPI | 1538743190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX BP10076076) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX 727622) |
| Enumeration Date | 2021-05-10 |
| Last Update Date | 2022-04-13 |