| NPI | 1568482339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: ND 18204) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: LA 023149) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2023-10-30 |