| NPI | 1588877641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: ID M-13729) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: SC 36567) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2020-08-04 |