| NPI | 1609161843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: AL 1352) |
| Additional Taxonomies | 208600000X Surgery (Licence: AL DO.1352) |
| 208600000X Surgery (Licence: FL UO2701) | |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2019-10-08 |