| NPI | 1629210216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 46981) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TN 53937) |
| Enumeration Date | 2009-03-30 |
| Last Update Date | 2024-12-11 |